- Email: [email protected]
Relationship Between Socioeconomic Factors and Quality of Anticoagulation
S324
BMV mitral valve area, presence of AF pre procedure, and the duration of follow up.
Canadian Journal of Cardiology Volume 29 2013
596 WHAT IS THE MOST COST-EFFECTIVE METHOD TO PREVENT RHEUMATIC HEART DISEASE IN A DEVELOPING WORLD COUNTRY? RA Manji, J Witt, Y Jung, R Northcott, AH Menkis
595 RELATIONSHIP BETWEEN SOCIOECONOMIC FACTORS AND QUALITY OF ANTICOAGULATION A Starovoytov, AT Verma, CM Taylor, S Sharifi, J MacGillivray, M Sidsworth, J Hope, R Fox, K Gin, K Ramanathan Vancouver, British Columbia BACKGROUND:
Time in the therapeutic range (TTR) assesses the appropriateness of international normalized ratio (INR) control during warfarin therapy. Poor adherence to warfarin therapy is a major contributor to sub-therapeutic coagulation or bleeding complications. Our objective was to examine the association between socio-economic factors and TTR in the city of Vancouver, Canada. METHODS: De-identified laboratory INR data including test dates, age, sex and a partial postal code variable FSA (forward sortation area) were obtained from a local outpatient laboratory chain (LifeLabs) for a period between 2005 and 2010. The TTR was calculated using Rosendaal's method. We then compared regions within Vancouver with below average TTR. Data corresponding to the city of Vancouver was linked to the census 2006 data using FSA and included variables describing employment, income, education, housing, ethnic origin, migration, language and family status. RESULTS: Our cohort consisted of n¼8595 patients with a mean age of 70.814 y and a TTR of 55.222%. Both sexes has similar TTR. We identified a few city neighborhoods with significantly lower than average TTR (47.425 vs. 55.722%, p<0.001) and grouped them together. Areas with lower than average TTR had younger population (66.013 vs. 71.214 years, p<0.001), and longer average periods between INR testing (32.235 vs. 26.024 days, p<0.001). Census data showed that areas at risk had higher unemployment rates (9.42.3 vs. 5.80.8 %, p<0.001), a higher proportion of people with less than high school education (209.6 vs. 8.36.3%, p¼0.019), who were more likely to work in trades (9.50.4 vs. 5.92.0%, p¼0.025), to be divorced or widowed (22.86 vs. 14.21.8% p<0.001), and have a significantly lower average income (22.55.8 vs. 43.123.3 thousands, p<0.001). Areas with higher than average TTR were represented by an older population (73.213 vs. 69.414 years, p <0.001), with higher proportion of people with university degree (53.710 vs. 36.712 %, p¼0.007), who had significantly higher average income (60.131.4 vs. 32.510.7 thousands, p¼0.006) CONCLUSION: The overall anticoagulation control in our cohort was comparable to those previously reported. Socioeconomic factors should be considered when prescribing antithrombotic therapy and more resources should be allocated to the areas where a higher prevalence of sub-optimal factors is present.
Winnipeg, Manitoba BACKGROUND: Rheumatic heart disease (RHD) secondary to strep throat (GAS) is endemic in the developing world causing morbidity, mortality, lost productivity (affecting country GDP) and significant costs to the patient and the healthcare system. Many patients do not get care. Three strategies were examined (versus standard no prevention) in a cost-effectiveness analysis (CEA) for preventing RHD: primary prophylaxis with benzathine penicillin G (BPG) once monthly to all patients (ages 5-21); secondary prophylaxis with BPG monthly only to those with echocardiographic (echo) evidence of developing RHD (till age 21); and throat swab to detect and subsequently treat GAS as needed. METHODS: A Markov model compared the strategies versus no prevention over the lifetime of an urban living child from age 5 taking a societal perspective. Annual risks for RHD in model (base rates): 0.021 (no prevention), 0.001 (primary prophylaxis), 0.003(secondary prophylaxis) and 0.006 (GAS treatment). Risks incorporate non-compliance and antibiotic resistance. Direct costs of each strategy, including fixed costs (echo machine and labour), and all per person costs included. Indirect costs of lost productivity based on per capita GDP included. Quality adjusted life years (QALY) for RHD with treatment/complications included. Annual age-standardized mortality from all other causes included. RESULTS: Primary prophylaxis (US$2,499/QALY) is most CE compared to no prevention (generates the most QALYs, though highest expected lifetime cost per person). The incremental CE of primary prophylaxis versus secondary prophylaxis is US$7,185/QALY and US$41,671/QALY versus GAS treatment. Sensitivity analysis shows ranking of strategies depends on various parameters: if probability of developing RHD is greater than 0.01 (10 times base rate) with primary prophylaxis (eg. from non-compliance), then secondary prophylaxis is more CE; if compliance with GAS treatment is greater than 0.75, then GAS treatment is most CE. CONCLUSION: Primary prophylaxis with monthly BPG is most CE in our model; however, any strategy is more CE than no prevention when consider lost productivity and decrease GDP in a country that needs to increase economic output.
597 CARDIOVASCULAR DISEASE RISK PERCEPTION IN A DEVELOPING WORLD COUNTRY - BASED ON LOCATION OF RESIDENCE AND GENDER RA Manji, R Northcott, AH Menkis Winnipeg, Manitoba BACKGROUND: The World Health Organization has declared cardiovascular disease (CVD) as the number one cause of
BMV mitral valve area, presence of AF pre procedure, and the duration of follow up.
Canadian Journal of Cardiology Volume 29 2013
596 WHAT IS THE MOST COST-EFFECTIVE METHOD TO PREVENT RHEUMATIC HEART DISEASE IN A DEVELOPING WORLD COUNTRY? RA Manji, J Witt, Y Jung, R Northcott, AH Menkis
595 RELATIONSHIP BETWEEN SOCIOECONOMIC FACTORS AND QUALITY OF ANTICOAGULATION A Starovoytov, AT Verma, CM Taylor, S Sharifi, J MacGillivray, M Sidsworth, J Hope, R Fox, K Gin, K Ramanathan Vancouver, British Columbia BACKGROUND:
Time in the therapeutic range (TTR) assesses the appropriateness of international normalized ratio (INR) control during warfarin therapy. Poor adherence to warfarin therapy is a major contributor to sub-therapeutic coagulation or bleeding complications. Our objective was to examine the association between socio-economic factors and TTR in the city of Vancouver, Canada. METHODS: De-identified laboratory INR data including test dates, age, sex and a partial postal code variable FSA (forward sortation area) were obtained from a local outpatient laboratory chain (LifeLabs) for a period between 2005 and 2010. The TTR was calculated using Rosendaal's method. We then compared regions within Vancouver with below average TTR. Data corresponding to the city of Vancouver was linked to the census 2006 data using FSA and included variables describing employment, income, education, housing, ethnic origin, migration, language and family status. RESULTS: Our cohort consisted of n¼8595 patients with a mean age of 70.814 y and a TTR of 55.222%. Both sexes has similar TTR. We identified a few city neighborhoods with significantly lower than average TTR (47.425 vs. 55.722%, p<0.001) and grouped them together. Areas with lower than average TTR had younger population (66.013 vs. 71.214 years, p<0.001), and longer average periods between INR testing (32.235 vs. 26.024 days, p<0.001). Census data showed that areas at risk had higher unemployment rates (9.42.3 vs. 5.80.8 %, p<0.001), a higher proportion of people with less than high school education (209.6 vs. 8.36.3%, p¼0.019), who were more likely to work in trades (9.50.4 vs. 5.92.0%, p¼0.025), to be divorced or widowed (22.86 vs. 14.21.8% p<0.001), and have a significantly lower average income (22.55.8 vs. 43.123.3 thousands, p<0.001). Areas with higher than average TTR were represented by an older population (73.213 vs. 69.414 years, p <0.001), with higher proportion of people with university degree (53.710 vs. 36.712 %, p¼0.007), who had significantly higher average income (60.131.4 vs. 32.510.7 thousands, p¼0.006) CONCLUSION: The overall anticoagulation control in our cohort was comparable to those previously reported. Socioeconomic factors should be considered when prescribing antithrombotic therapy and more resources should be allocated to the areas where a higher prevalence of sub-optimal factors is present.
Winnipeg, Manitoba BACKGROUND: Rheumatic heart disease (RHD) secondary to strep throat (GAS) is endemic in the developing world causing morbidity, mortality, lost productivity (affecting country GDP) and significant costs to the patient and the healthcare system. Many patients do not get care. Three strategies were examined (versus standard no prevention) in a cost-effectiveness analysis (CEA) for preventing RHD: primary prophylaxis with benzathine penicillin G (BPG) once monthly to all patients (ages 5-21); secondary prophylaxis with BPG monthly only to those with echocardiographic (echo) evidence of developing RHD (till age 21); and throat swab to detect and subsequently treat GAS as needed. METHODS: A Markov model compared the strategies versus no prevention over the lifetime of an urban living child from age 5 taking a societal perspective. Annual risks for RHD in model (base rates): 0.021 (no prevention), 0.001 (primary prophylaxis), 0.003(secondary prophylaxis) and 0.006 (GAS treatment). Risks incorporate non-compliance and antibiotic resistance. Direct costs of each strategy, including fixed costs (echo machine and labour), and all per person costs included. Indirect costs of lost productivity based on per capita GDP included. Quality adjusted life years (QALY) for RHD with treatment/complications included. Annual age-standardized mortality from all other causes included. RESULTS: Primary prophylaxis (US$2,499/QALY) is most CE compared to no prevention (generates the most QALYs, though highest expected lifetime cost per person). The incremental CE of primary prophylaxis versus secondary prophylaxis is US$7,185/QALY and US$41,671/QALY versus GAS treatment. Sensitivity analysis shows ranking of strategies depends on various parameters: if probability of developing RHD is greater than 0.01 (10 times base rate) with primary prophylaxis (eg. from non-compliance), then secondary prophylaxis is more CE; if compliance with GAS treatment is greater than 0.75, then GAS treatment is most CE. CONCLUSION: Primary prophylaxis with monthly BPG is most CE in our model; however, any strategy is more CE than no prevention when consider lost productivity and decrease GDP in a country that needs to increase economic output.
597 CARDIOVASCULAR DISEASE RISK PERCEPTION IN A DEVELOPING WORLD COUNTRY - BASED ON LOCATION OF RESIDENCE AND GENDER RA Manji, R Northcott, AH Menkis Winnipeg, Manitoba BACKGROUND: The World Health Organization has declared cardiovascular disease (CVD) as the number one cause of